Straczek H, Vieux R, Hubert C, Miton A, Hascoet J-M
Maternité régionale, Nancy université, 10, rue du Docteur-Heydenreich, 54042 Nancy, France.
Arch Pediatr. 2008 Jun;15(6):1076-82. doi: 10.1016/j.arcped.2008.02.022. Epub 2008 May 5.
Following Nordic and Anglo-Saxon countries, France is directing towards an early discharge policy from maternity hospitals. French National Authority for Health has published recommendations focusing on the importance to highlight the dangers of such a policy so as to be able to anticipate them.
To describe the complications diagnosed in the newborn infants from day 2 to the current hospital's discharge (noteworthy, if infants are discharged early, these complications may occur at home) to determine predictive factors and to validate those proposed by the French National Authority for Health.
Prospective study conducted in the maternity ward of Nancy's level III facility, from January 6th to May 6th 2005.
Nine hundred and three newborn infants were included. Forty-two (4.6%) presented with complications diagnosed from day 2 to hospital's discharge, among which 4 required urgent neonatal care. The most frequent complication was hyperbilirubinemia: 23 newborns were treated with phototherapy between day 2 and day 10. Statistically significant risk factors of hyperbilirubinemia after day 2 in multivariate analysis were instrumental vaginal delivery (OR=2.94; CI 95% [1.04-8.34]) and jaundice before day 2 (OR=7.39; CI 95% [2.66-20.55]). According to the French National Authority for Health's policy, 33 among 42 infants presenting with a complication would have been withdrawn from an early discharge program.
In our population, French National Authority for Health's recommendations were relevant to guide an early discharge project.
继北欧和盎格鲁 - 撒克逊国家之后，法国正朝着妇产医院早期出院政策的方向发展。法国国家卫生管理局已发布相关建议，着重强调了此类政策存在的风险，以便能够提前做好应对准备。
描述从出生第2天到当前医院出院期间（值得注意的是，如果婴儿提前出院，这些并发症可能在家中发生）新生儿被诊断出的并发症，确定预测因素，并验证法国国家卫生管理局提出的相关因素。
2005年1月6日至5月6日在南锡三级医疗机构的产科病房进行前瞻性研究。
共纳入903名新生儿。42名（4.6%）新生儿在出生第2天到出院期间被诊断出患有并发症，其中4名需要紧急新生儿护理。最常见的并发症是高胆红素血症：23名新生儿在出生第2天至第10天接受了光疗。多因素分析显示，出生第2天后高胆红素血症的统计学显著危险因素为产钳助产（OR = 2.94；95%置信区间[1.04 - 8.34]）和出生第2天前出现黄疸（OR = 7.39；95%置信区间[2.66 - 20.55]）。根据法国国家卫生管理局的政策，42名出现并发症的婴儿中有33名将会被排除在早期出院计划之外。
在我们的研究人群中，法国国家卫生管理局的建议对于指导早期出院项目具有重要意义。
